.: ORİJİNAL ARAŞTIRMA
Soliter Böbrekli Hastalarda İnflamasyonun Böbrek Fonksiyonlarına Etkisi
The Effect of Inflammation on Renal Functions in Patients with Solitary Kidney
Turkiye Klinikleri J Intern Med. 2021;6(1):1-5
doi: 10.5336/intermed.2020-75301
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Soliter böbrekli bireylerde, zaman içinde glomerüler hiperfiltrasyon nedeniyle mevcut olan böbrekte hasar gelişir. Yüksek tansiyon, proteinüri, kan şekeri düzeyleri gibi geleneksel nedenlerin yanı sıra anemi, malnütrisyon, inflamasyon gibi kronik böbrek hastalığı ilişkili faktörler de bu gidişatı hızlandırabilir. Çalışmamızın amacı, soliter böbrekli bireylerde glomerüler filtrasyon hızını (GFH) etkileyebilecek, inflamasyon dâhil olası nedenleri araştırmaktır. Gereç ve Yöntemler: Çalışmaya, 75 doğuştan, 117 sonradan kazanılmış tek böbreği olan, 192 hasta alındı. İlk ve son başvuru anındaki bazı laboratuvar veriler ve demografik özellikler kaydedildi. Son başvurudaki GFH'den, ilk başvurudaki GFH çıkartılıp, elde edilen fark 0 değerinden küçükse GFH kötüye giden, büyükse GFH iyiye giden grup olacak şekilde 2 alt grup oluşturuldu. Bulgular: Çalışmaya aldığımız hastaların yaş ortalaması %57,2±15,24 olup %38,5'i erkekti. Sonradan soliter böbrekli olan grupta, doğuştan soliter böbrekli gruba göre ilk ve son başvuru anındaki GFH daha düşük, yaşları daha ileri, bilinen süre daha kısa, kardiyovasküler hastalık görülme yüzdesi daha fazlaydı. Çok değişkenli Cox regresyon analizinde; GFH'ye doğuştan soliter böbrekli olan bireylerde, ilk başvuru anındaki proteinürinin [Hazard oranı (HR)=1 p=0,000] ve alyuvar dağılım hacminin (RDW) (HR=1,39 p=0,018), sonradan soliter böbrekli olan bireylerde ise ilk başvuru anındaki proteinürinin (HR=1 p=0,008) ve hemoglobinin (HR=-0,842 p=0,46) etki ettiği görüldü. RDW'nin etkisi ise hemoglobin ve nötrofil lenfosit oranıyla arasındaki korelasyondan, anemi ve inflamasyon üzerinden olduğu anlaşıldı. Sonuç: Sonradan soliter böbrekli olan bireylerde GFH, doğuştan olan bireylere göre daha hızlı bozulmaktadır. Bu bozulma; ileri yaş, komorbid hastalıklar, proteinüri düzeylerinin yanı sıra artmış inflamasyon durumu, hemoglobin seviyesindeki düşüşlere bağlı da olabilir.
Anahtar Kelimeler: Glomerüler filtrasyon hızı; inflamasyon; alyuvar dağılım hacmi; soliter böbrek
Amaç: Soliter böbrekli bireylerde, zaman içinde glomerüler hiperfiltrasyon nedeniyle mevcut olan böbrekte hasar gelişir. Yüksek tansiyon, proteinüri, kan şekeri düzeyleri gibi geleneksel nedenlerin yanı sıra anemi, malnütrisyon, inflamasyon gibi kronik böbrek hastalığı ilişkili faktörler de bu gidişatı hızlandırabilir. Çalışmamızın amacı, soliter böbrekli bireylerde glomerüler filtrasyon hızını (GFH) etkileyebilecek, inflamasyon dâhil olası nedenleri araştırmaktır. Gereç ve Yöntemler: Çalışmaya, 75 doğuştan, 117 sonradan kazanılmış tek böbreği olan, 192 hasta alındı. İlk ve son başvuru anındaki bazı laboratuvar veriler ve demografik özellikler kaydedildi. Son başvurudaki GFH'den, ilk başvurudaki GFH çıkartılıp, elde edilen fark 0 değerinden küçükse GFH kötüye giden, büyükse GFH iyiye giden grup olacak şekilde 2 alt grup oluşturuldu. Bulgular: Çalışmaya aldığımız hastaların yaş ortalaması %57,2±15,24 olup %38,5'i erkekti. Sonradan soliter böbrekli olan grupta, doğuştan soliter böbrekli gruba göre ilk ve son başvuru anındaki GFH daha düşük, yaşları daha ileri, bilinen süre daha kısa, kardiyovasküler hastalık görülme yüzdesi daha fazlaydı. Çok değişkenli Cox regresyon analizinde; GFH'ye doğuştan soliter böbrekli olan bireylerde, ilk başvuru anındaki proteinürinin [Hazard oranı (HR)=1 p=0,000] ve alyuvar dağılım hacminin (RDW) (HR=1,39 p=0,018), sonradan soliter böbrekli olan bireylerde ise ilk başvuru anındaki proteinürinin (HR=1 p=0,008) ve hemoglobinin (HR=-0,842 p=0,46) etki ettiği görüldü. RDW'nin etkisi ise hemoglobin ve nötrofil lenfosit oranıyla arasındaki korelasyondan, anemi ve inflamasyon üzerinden olduğu anlaşıldı. Sonuç: Sonradan soliter böbrekli olan bireylerde GFH, doğuştan olan bireylere göre daha hızlı bozulmaktadır. Bu bozulma; ileri yaş, komorbid hastalıklar, proteinüri düzeylerinin yanı sıra artmış inflamasyon durumu, hemoglobin seviyesindeki düşüşlere bağlı da olabilir.
Anahtar Kelimeler: Glomerüler filtrasyon hızı; inflamasyon; alyuvar dağılım hacmi; soliter böbrek
ABSTRACT
Objective: In individuals with solitary kidneys, damage develops in the existing kidney due to glomerular hyperfiltration over time. In addition to traditional causes such as high blood pressure, proteinuria, blood glucose levels, factors related to chronic kidney disease such as anemia, malnutrition, inflammation can accelerate this process.The aim of our study is to investigate possible causes, including inflammation, that may affect the glomerular filtration rate in individuals with solitary kidney. Material and Methods: 192 patients with solitary kidney (75 congenital and 117 acquired) were included in the study. Laboratory data and demographic features at the time of first and last visit were recorded. Glomerular filtration rate(GFR) at the first visit was subtracted from the GFR at the last visit, and two subgroups were created. The worsening group consisted of individuals with a change in GFR less than zero, while the improvement group consisted of individuals with a change in GFR greater than zero. Results: The average age of the patients we included in the study was 57.2±15.24 years, and 38.5% of them were male. In the group with acquired solitary kidney, the GFR at the time of the first and last visit was lower, the age was older, the known period was shorter, and the percentage with cardiovascular disease was higher compared with the group with congenital solitary kidney. Multivariate Cox regression of all data shows that proteinuria (HR=1, p=0.000) and red blood cell distribution width (RDW) (HR=1.39, p=0.018) have effects on GFR at the first admission of the individuals with congenital solitary kidney and proteinuria (HR=1, p=0.008) and hemoglobin (HR=-0.842, p=0.46) have effects on GFR at first admission in individuals with acquired solitary kidney. The effect of RDW was found through anemia and inflammation due to the correlation between hemoglobin and neutrophil lymphocyte ratio. Conclusion: GFR deteriorates faster in individuals with acquired solitary kidney compared to individuals with congenital solitary kidney. This deterioration might be due to advanced age, comorbid diseases, proteinuria levels, as well as increased inflammation status and decreases in hemoglobin levels.
Keywords: Glomerular filtration rate; inflammation; red blood cell distribution width; solitary kidney
Objective: In individuals with solitary kidneys, damage develops in the existing kidney due to glomerular hyperfiltration over time. In addition to traditional causes such as high blood pressure, proteinuria, blood glucose levels, factors related to chronic kidney disease such as anemia, malnutrition, inflammation can accelerate this process.The aim of our study is to investigate possible causes, including inflammation, that may affect the glomerular filtration rate in individuals with solitary kidney. Material and Methods: 192 patients with solitary kidney (75 congenital and 117 acquired) were included in the study. Laboratory data and demographic features at the time of first and last visit were recorded. Glomerular filtration rate(GFR) at the first visit was subtracted from the GFR at the last visit, and two subgroups were created. The worsening group consisted of individuals with a change in GFR less than zero, while the improvement group consisted of individuals with a change in GFR greater than zero. Results: The average age of the patients we included in the study was 57.2±15.24 years, and 38.5% of them were male. In the group with acquired solitary kidney, the GFR at the time of the first and last visit was lower, the age was older, the known period was shorter, and the percentage with cardiovascular disease was higher compared with the group with congenital solitary kidney. Multivariate Cox regression of all data shows that proteinuria (HR=1, p=0.000) and red blood cell distribution width (RDW) (HR=1.39, p=0.018) have effects on GFR at the first admission of the individuals with congenital solitary kidney and proteinuria (HR=1, p=0.008) and hemoglobin (HR=-0.842, p=0.46) have effects on GFR at first admission in individuals with acquired solitary kidney. The effect of RDW was found through anemia and inflammation due to the correlation between hemoglobin and neutrophil lymphocyte ratio. Conclusion: GFR deteriorates faster in individuals with acquired solitary kidney compared to individuals with congenital solitary kidney. This deterioration might be due to advanced age, comorbid diseases, proteinuria levels, as well as increased inflammation status and decreases in hemoglobin levels.
Keywords: Glomerular filtration rate; inflammation; red blood cell distribution width; solitary kidney
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